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Hyperhomocysteinemia and restenosis
S D Kumbasar1, I Dinçer, F Ertas
1Cardiology Department, Ankara University Medical School, Ankara, Turkey. drkumbasar@superonline.com
Insights
Elevated plasma homocysteine levels significantly increase the risk of restenosis after coronary angioplasty. This finding highlights homocysteine as a key factor in post-procedure outcomes.
Area of Science:
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Coronary angioplasty is a common procedure to treat coronary artery disease.
- Restenosis, the re-narrowing of the artery after angioplasty, remains a significant clinical challenge.
- Plasma homocysteine has been investigated as a potential risk factor for cardiovascular events.
Purpose of the Study:
- To evaluate the association between plasma homocysteine levels and the occurrence of angiographic restenosis six months post-coronary angioplasty.
- To identify independent risk factors for restenosis after percutaneous transluminal coronary angioplasty and stenting.
Main Methods:
- A prospective study involving 100 patients undergoing coronary angioplasty.
- Plasma homocysteine levels were measured at the time of the procedure.
- 56 patients with follow-up angiograms were analyzed, categorized into restenosis (Group A) and no-restenosis (Group B) groups.
Main Results:
- Patients with restenosis had significantly higher mean plasma homocysteine levels (15.2 mumol/l) compared to those without restenosis (11.1 mumol/l).
- The restenosis rate was substantially higher in the upper tertile of homocysteine levels (89.5%) versus the lower tertile (47.4%).
- Elevated homocysteine remained a significant independent risk factor for restenosis even after adjusting for multiple clinical variables.
Conclusions:
- Increased plasma homocysteine is an independent risk factor for angiographic restenosis following coronary angioplasty and stenting.
- Diabetes mellitus was also identified as an independent risk factor for restenosis.
- These findings suggest that homocysteine levels may play a crucial role in the development of restenosis.
Objective:
This study was undertaken to assess the effect of plasma homocysteine level on angiographic restenosis 6 months after coronary angioplasty.
Methods:
The plasma homocysteine level was measured in 100 consecutive patients at the time of coronary angioplasty, 56 patients who attended a 6-month follow-up angiogram being enrolled to the study; the 44 patients without a control coronary angiogram were not enrolled. Patients with and without angiographic restenosis were designated as groups A (n = 34) and B (n = 22) respectively.
Results:
The baseline demographic (groups A and B), angiographic (groups A and B) and procedural characteristics were similar in both groups. The mean plasma homocysteine level (SD) was 15.2 (7.7) and 11.1 (2.5) mumol/l in groups A and B respectively (P = 0.007; 95% CI -6.9 to -1.1). With respect to the plasma homocysteine level, the upper and the lower thirds were compared by binary logistic regression (the lower third homocysteine level being < 10.6 mumol/l and the upper third homocysteine level > 14.1 mumol/l). The angiographic restenosis rate for the lower and upper tertiles was 47.4% and 89.5% respectively (P = 0.01; OR = 9.4; 95% CI 1.6-52.7). After adjustment for age and sex, the statistical significance did not change (P = 0.013; OR = 9.43; 95% CI 1.6-54.9). Even after adjustment for age, sex, smoking, hypertension, hypercholesterolemia, and diabetes mellitus, there was a statistically significant difference between the upper and lower tertiles (P = 0.008; OR = 41.3; 95% CI 2.6-635).
Conclusion:
Increased plasma homocysteine level and diabetes mellitus were independent risk factors for angiographic restenosis after percutaneous transluminal coronary angioplasty and coronary stenting.